Parameters:
(1) creatinine clearance in mL per min
(2) body weight in kilograms
(3) dialysis status
creatinine clearance per kg body weight =
= (creatinine clearance) / (body weight in kg)
vancomycin clearance in mL/min per kg body weight =
= 0.075 * (creatinine clearance per kg)
daily dose (mg per 24 hours) per kg body weight =
= (15.4736 * (creatinine clearance per kg)) - 0.0472
daily dose in mg per 24 hours =
= (daily dose in mg per kg) * (body weight in kilograms)
In general individual doses should be from 250 to 500 mg, not to exceed 1,000 mg.
If the vancomycin half-life is prolonged then a loading dose of 15 mg per kg body weight should be considered. Otherwise it will take several days (4-5 half-lives of the drug) to reach steady state.
If a patient is anephric and on dialysis then use a daily dose of 1.9 mg per kg body weight.
If the calculated daily dose is very small, then an alternative is to administer a larger dose every few days.
Rapid infusion of vancomycin (> 500 mg in 30 minutes, or > 16 mg per minute) can result in a histamine release syndrome, so a slow infusion is preferred.
